This refers to any object lodged in the ear canal, nasal cavity, or throat (pharynx or larynx) that is not naturally supposed to be there. These occurrences are common, especially in children, but can affect individuals of all ages.

Foreign Bodies in the Ear (Otic Foreign Bodies)

Definition: An object present in the external auditory canal (ear canal) or, rarely, the middle ear.

Common Objects:

• • Children: Beads, small toy parts, paper, crayons, food items (e.g., seeds, peas), insects, cotton swab tips.

  • Adults: Cotton swab tips, hearing aid parts (domes, batteries), insects, earplugs.

Symptoms:

• Often asymptomatic initially, especially if small and inert.

• Ear pain (otalgia).

• Feeling of fullness or blockage in the ear.

• Hearing loss or muffled hearing on the affected side.

• Itching or irritation.

• Discharge from the ear (otorrhea), which may be foul-smelling if the object has been present for a while or has caused infection.

• Ringing in the ear (tinnitus) or dizziness (vertigo) can occur but are less common.

• If an insect is alive, the patient may report buzzing, movement, or significant distress.

Diagnosis:

• Direct visualization using an otoscope.

• History from the patient or caregiver.

Management/Removal:

• • Attempting removal at home is generally discouraged as it can push the object further in or damage the ear canal or eardrum.

  • Professional Removal Techniques:

    • Irrigation: Flushing the ear canal with warm water or saline (contraindicated if there’s a suspected eardrum perforation or if the object is organic and may swell, e.g., seeds, beans).

    • Instrumentation: Using specialized tools like forceps, hooks, or suction under direct vision (otoscope or microscope).

    • Insects: May first be killed by instilling mineral oil, olive oil, or lidocaine into the ear canal before removal.

    • Button batteries: Require urgent removal due to risk of liquefaction necrosis and severe tissue damage.

  • Sedation or general anesthesia may be required, especially for uncooperative children or deeply impacted objects.

  • Antibiotic ear drops may be prescribed if there is associated infection or trauma.

Foreign Bodies in the Nose (Nasal Foreign Bodies)

Definition: An object lodged within one of the nasal cavities.

Common Objects:

• • Primarily seen in children: Beads, small toy parts, paper, food items (e.g., nuts, seeds, peas), button batteries, foam pieces.

  • Less common in adults, but can occur (e.g., gauze packing left after surgery, parts of nasal sprays).

Symptoms:

• Often unilateral (affecting one nostril).
• Unilateral foul-smelling nasal discharge (rhinorrhea), often purulent or bloody – a classic sign, especially if persistent.
• Nasal obstruction or difficulty breathing through one nostril.
• Nasal irritation, sneezing.
• Facial pain or headache on the affected side.
• Epistaxis (nosebleed).
• Bad breath (halitosis).
• Some children may not report the insertion and symptoms may be delayed.

Diagnosis:

• History from the patient or caregiver.

• Direct visualization using a nasal speculum and good lighting, or a nasal endoscope.

• X-rays may be useful for radiopaque objects (e.g., metal, button batteries) but are often not necessary for common items.

Management/Removal:

• “Parent’s Kiss” or “Mother’s Kiss” Technique: For cooperative children; the parent occludes the unaffected nostril and blows a sharp puff of air into the child’s mouth, potentially dislodging the object.

• Professional Removal Techniques:

  • Using specialized instruments like nasal forceps, hooks, or suction under direct vision.

  • Positive pressure techniques (e.g., using an Ambu bag over the mouth and unaffected nostril).

  • Topical decongestants and local anesthetics may be applied to improve visualization and comfort.

  • Button batteries: Constitute an emergency and require immediate removal due to the risk of rapid tissue damage, septal perforation, and liquefaction necrosis.

• Sedation or general anesthesia may be needed for uncooperative patients or difficult-to-remove objects.

• Antibiotics may be prescribed if secondary infection (sinusitis) is present.

Foreign Bodies in the Throat (Pharyngeal/Laryngeal/Esophageal Inlet Foreign Bodies)

Definition: An object lodged in the pharynx (throat), larynx (voice box), or upper esophagus.

Common Objects:

• • Food Bolus: Most common, especially fish bones, chicken bones, pieces of meat.

  • Non-food items: Coins, small toy parts, dentures, pins, button batteries.

Location and Associated Symptoms:

• Pharynx (e.g., tonsils, base of tongue, vallecula, pyriform sinus):

  • Sensation of something stuck in the throat (globus sensation).

  • Pain, especially on swallowing (odynophagia).

  • Difficulty swallowing (dysphagia).

  • Excessive salivation or drooling.

  • Coughing, gagging.

• Larynx (voice box):

  • More critical due to airway obstruction risk.

  • Sudden onset of coughing, choking, gagging.

  • Hoarseness or voice changes (dysphonia) or inability to speak (aphonia).

  • Difficulty breathing (dyspnea), stridor (a high-pitched wheezing sound).

  • Cyanosis (bluish discoloration of the skin) if airway obstruction is severe. This is a medical emergency.

• Esophageal Inlet/Upper Esophagus:

  • Dysphagia, odynophagia.

  • Retrosternal (behind the breastbone) pain or discomfort.

  • Regurgitation of undigested food.

  • Drooling.

  • Refusal to eat (especially in children).

Diagnosis:

• History of ingestion or choking episode.

• Direct visualization:

  • Oral examination with a tongue depressor.

  • Indirect laryngoscopy (using a mirror).

  • Flexible or rigid endoscopy (laryngoscopy, pharyngoscopy, esophagoscopy) is often required for definitive diagnosis and removal.

• Imaging:

  • X-rays (neck, chest) can identify radiopaque objects (e.g., bones, coins, button batteries). However, many foreign bodies (e.g., fish bones, plastic) are not visible on plain X-rays.

  • CT scan may be used for better localization or suspected complications.

Management/Removal:

• Airway Assessment: If laryngeal foreign body is suspected with signs of respiratory distress, securing the airway is the top priority (e.g., Heimlich maneuver for complete obstruction, advanced airway management).

• Pharyngeal Foreign Bodies:

  • Many can be removed in an outpatient setting using forceps (e.g., Magill forceps) under direct vision or with indirect laryngoscopy.

• Laryngeal/Esophageal Foreign Bodies:

  • Typically require removal under direct vision via laryngoscopy or esophagoscopy, usually under general anesthesia.

  • Specialized forceps and instruments are used.

  • Button batteries lodged in the esophagus are a true emergency due to rapid caustic injury and risk of perforation; immediate endoscopic removal is mandatory.

• Observation may be appropriate for small, smooth objects expected to pass spontaneously through the esophagus, but this is decided on a case-by-case basis.

Complications:

• Airway obstruction (laryngeal).

• Infection, abscess formation.

• Perforation of the ear canal, nasal septum, pharynx, or esophagus.

• Mediastinitis (if esophageal perforation occurs).

• Stricture formation (esophageal).

• Damage from button batteries (necrosis, perforation, fistula).